The Business Case for Integration

Mental Health Community Case Management and Its Effect on Healthcare Expenditures
This journal article written by Joseph Parks, MD; Tim Swinfard, MS; and Pauk Stuve, PhD found that people with severe mental illness served by public mental health systems have rates of co-occurring chronic medical illnesses that of two to three times higher than the general population, with a corresponding life expectancy of 25 years less. Treatment of these chronic medical conditions in those with serious mental illness is often substandard, with many receiving no treatment at all. Much of the treatment they do receive comes from costly ER visits and inpatient stays, rather than routine screenings and preventive medicine.

Financing, Policy and Integration of Services
The purpose of this discussion paper on the current state of financing and policy support for behavioral health and primary care integration is to bring together multiple strands of information to support future policy change at the federal and state levels.

Financing Integrated Care: Working Creatively Within Existing Opportunities
In a National Council Magazine article, Integrated Health Program Specialist Kathy Reynolds offers a review of immediate solutions to fund integrated care programs in Medicaid fee-for-service and capitated states.

Reimbursement of Mental Health Services in Primary Care Settings
SAMHSA's 2008 report provides a look at some of the payment policies and practices that may prohibit or discourage the provision of mental health services in primary care settings.

The Business Case for Bidirectional Integrated Care
The California Integration Policy Initiative (CiMH) has released an updated resource on the business case for integrated care, highlighting the importance of having primary care capacity in behavioral health settings and behavioral health capacity in primary care settings.

Billing Tools and Resources

Medicaid/Medicare

“Mental Health Services” Booklet 
A new publication titled “Mental Health Services” is now available from the Medicare Learning Network.” This booklet is designed to provide education on mental health services, including covered mental health services, mental health services that are not covered, mental health professionals, outpatient psychiatric hospital services, and inpatient psychiatric hospital services.  

Medicaid Reimbursement for Behavioral Health Services
The following is clarification from CMS regarding the statutory requirements pertaining to Medicaid reimbursement to FQHCs and RHCs for behavioral health services. Read the memo here.

Medicaid Reimbursement for Services Provided in FQHCs and RHCs by Clinical Psychologists, Clinical Social Workers and Nurse Practitioners
The following is clarification from CMS regarding the requirements pertaining to Medicaid reimbursement to FQHCs AND RHCs for services provided by Clinical Psychologists, Clinical Social Workers and Nurse Practitioners. Read the memo here.

Opportunities for Medicare patients to receive preventative services
The Affordable Care Act provides more opportunities for Medicare patients to receive preventive services. The American Medical Association brochure is a good reference for which preventive services and patients are covered. They have also developed a document on How to Bill Medicare’s Annual Wellness Visit.

Health and Behavior Assessment and Intervention Codes (HBAI)- 96150-96155 CPT Series
This assessment tool identifies the states where the Medicaid Health and Behavior Assessment Codes 96150-96155 CPT Series have been turned on. 

Environmental Assessment Tool, State Level Policy and Financing
This assessment tool helps organizations review their state level policy and financing environment and the extent to which it supports effective collaboration among behavioral health and primary care providers, especially regarding the Medicaid and “safety net” populations.

Health and Behavior Assessment and Intervention Codes (HBAI) - 
9600 Series
The American Psychological Association has recently released an online tool on using the HBAI codes. The tool is useful for primary and behavioral healthcare providers.
 
Health and Behavioral Codes
Developed by Maine Health this document provides information on using 96100 Health and Behavior codes in primary care settings.  

Paying for Behavioral Health Visits on Same Day as Medical Visit
Developed by NACHC and SAMHSA, this Map provides information on which states allow for same day billing of a behavioral health and a primary care visit.  Updated as of 9/14/09

Screening, Brief Intervention, and Referral to Treatment
The SBIRT system provides for brief intervention or brief treatment within the community setting, or motivates and refers those identified as needing more extensive services than provided in the community setting to a specialist setting for assessment, diagnosis, and appropriate treatment.

Private Payors

DIAMOND Initiative
The following two articles describe how private health plans are paying for the care management services associated with the implementation of the IMPACT Depression Program in Primary Care.
DIAMOND Project Overview
DIAMOND Return on Investment

Institute for Clinical Systems Improvement (ICSI). ICSI is the website for the DIAMOND Initiative. http://www.icsi.org/ 

Other Information and Resources

Recovery Support Services Definitions
The federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA) has posted five service definitions for peer and other recovery support services on its web site. 

• Recovery Support Services: Self-Directed Care
• Recovery Support Services: Behavioral Health Peer Navigator
• Recovery Support Services: Peer-Operated Recovery Community Center Recovery Support Services: Peer Recovery Support Coaching
• Recovery Support Services: Relapse Prevention/Wellness Recovery Support

Diabetes Education Services, Reimbursement Tips for Primary Care Practice
Diabetes self-management education/training is cost effective and improves health outcomes as patients maintain better control of their A1C. Physicians will benefit by establishing a relationship with a diabetes educator who can provide their services for patients with diabetes. This document serves as a guide for reimbursement for diabetes education services. 

An Unhealthy America: The Economic Burden of Chronic Disease
This interactive map provides useful statistics on the economic burden of chronic disease by state, including emotional disorders.

Depression and Costs of Healthcare
Psychosomatics, July-August 2009
Patients with depression had higher median per-patient annual non-mental health costs than patients without depression in all 11 diseases studied. There was also a higher-than-random comorbidity between depression and all 11 chronic comorbid diseases.

The Faces of Medicaid III: Refining the Portrait of People with Multiple Chronic Conditions
This report from the Centers for Health Care Strategies provides insights for targeting efforts to improve care and control spending for the program's highest-need, highest-cost beneficiaries.